Obesity Tied To Higher Risk Of Complications In Spinal Surgery

John Ratliff, M.D., assistant professor of neurological surgery and orthopedic surgery at Jefferson Medical College of Thomas Jefferson University in Philadelphia, reviewed 332 cases of thoracic and lumbar spinal surgery for routine degenerative conditions that he performed from 2002 to 2005 at Rush University Medical Center and the Neurological and Orthopedic Institute of Chicago.

He found that 71 percent of his patients were overweight, including 39 percent who were obese -- numbers, he says, that are not all that much different than from what is expected in the general U.S. population. That was surprising, he says, because "it makes sense to think that more people who need back surgery might be more likely to be overweight and obese, though evidence in the medical literature is unclear. We don't really know if obesity contributes to back pain."

Yet, Dr. Ratliff found a much higher incidence of complications in extremely overweight and obese patients, including blood clots, wound infections, heart problems, and deep vein thrombosis. "We found that the incidence of complications related directly to the degree of obesity," he says. "Not only does being obese raise the risk of complications, but the greater the obesity, the more the risk of having something go wrong around the time of surgery." He presents his findings on October 9, 2006 at the 2006 Congress of Neurological Surgeons Annual Meeting in Chicago.

Non-obese patients have an approximately 14-percent complication rate. But for those who are obese with a body-mass index (BMI) of 30 or greater, the incidence goes up to 20 percent. A BMI of 40 raises the complication rate to 36 percent.

These results aren't surprising he says, but no one has shown it in the spine surgery medical literature and it has not been proven in other surgery fields, such as cardiac or general surgery.

"Obesity and back pain is a Catch-22," he says. "A person is obese, has back pain, and the doctor says to exercise. But because of the pain, he may not be able to exercise enough and continues to put on weight. Then the back hurts more and he becomes even more inactive."

"The take-home message is, when considering elective spine surgery, a person who is extremely overweight might consider waiting a little while and losing some weight," Dr. Ratliff says. An individual's recovery will likely be easier and less complicated as well, he notes.

"If you're obese and having spine surgery, you need to know your risk for complications is higher than a comparable patient who is not obese," he says.